Institute:Office of National Coordinator (ONC) Workforce Training Curriculum
Component:The Culture of Health Care
Unit:Evidence-Based Practice
Lecture:Definition and application of EBM
Phrasing the clinical question
Slide content:Making Evidence-Based Clinical Decisions (Mulrow, 1997) 5.1 Figure: Adapted from Mulrow, Cook, & Davidoff, 1997 4
Slide notes:4 This lecture presents some definitions of evidence-based medicine and describes some of its applications. This diagram appeared in a paper by Mulrow [ muhl -row] and colleagues in 1997. It puts the use of evidence in the proper context. Basically, evidence is one of three aspects of what goes into making a clinical decision. First, we need to know what the research shows: the results of studies such as randomized trials and systematic reviews. But there are other factors that go into making a clinical decision. A second aspect is factors about the patient and/or the physician, such as cultural beliefs, personal values, experience, and education. Patients may have preferences. In addition, the patients physical reaction to treatment and medications may also play a significant role in clinical decision making. Physicians may have limitations in their skills, particularly if they practice in rural areas or places where the entire spectrum of medical services is not available. The third aspect of making clinical decisions is constraints. Formal policies and laws as well as community standards may influence decisions. Time may also be a constraintfor example, if a patient is acutely ill, there may not be enough time to do what the absolute best evidence would support. Then, of course, reimbursement issuessuch as what medications, treatments, and tests are covered by a patients insurancepresent further constraints on clinical decision making.